Provider Demographics
NPI:1710961941
Name:BAKHSHI, MANAVENDRA (MD)
Entity Type:Individual
Prefix:
First Name:MANAVENDRA
Middle Name:
Last Name:BAKHSHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 820933
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0933
Mailing Address - Country:US
Mailing Address - Phone:215-707-1136
Mailing Address - Fax:215-707-1142
Practice Address - Street 1:100 E LEHIGH AVE # MAB-204
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-1012
Practice Address - Country:US
Practice Address - Phone:215-707-1136
Practice Address - Fax:215-707-1142
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD052164L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0803108000OtherINDEPENDENCE BLUE CROSS
PA597586OtherMEDICARE GROUP TPI
PA778197OtherHIGHMARK BLUE SHIELD
PACD4829OtherRAILROAD MEDICARE GROUP TPI
PA2653OtherBRAVO HEALTH
PA451504OtherCOVENTRY HEALTH AMERICA
PA001604820Medicaid
PA01604820-07OtherAMERICHOICE
PA5959583OtherAETNA PPO
PAP00022197OtherRAILROAD MEDICARE
PA3207161OtherAETNA HMO
PA1072701OtherKEYSTONE MERCY HEALTH PLA
PA3Y5968OtherHEALTH NET
PA3207161OtherAETNA HMO
G06688Medicare UPIN